Clinical ophthalmology (Auckland, N.Z.)最新文献

Occupational eye injuries (OEIs) remain a major public health issue despite regulatory efforts toward increasing protective eyewear use. OEIs encompass a wide spectrum of trauma, from superficial injury to tissue melt and globe rupture. These injuries are associated with substantial medical, economic, and social burden. This narrative review identifies risk factors associated with OEIs, differences based on workplace, and barriers to OEI prevention. Risks for OEI include male sex, low educational attainment, low income, or being a temporary or migrant worker. Certain industries such as metalworking, construction and manufacturing, chemical handling, and agriculture, also carry unique ocular hazards that predispose workers to OEIs. Although many OEIs are minor, those that cause severe injury can result in permanent visual loss and blindness. Industrial and construction workers are frequently exposed to high-velocity foreign bodies (FBs) and blunt trauma, while agricultural workers are at elevated risk for open globe injuries, FBs and the vision-threatening sequalae of infection from organic material. Chemical injuries, although less common, are notable for high rates of bilateral eye involvement, often requiring urgent intervention. Unfortunately, most OEIs occur in the absence of proper protective eyewear. Barriers range from discomfort and poor fit, inadequate access, and lack of perceived need, all of which contribute to low compliance in various occupational settings. Current evaluations of behavioral and regulatory interventions to increase adherence show promise but with mixed results. Advances in protective eyewear technology that optimize comfort and usage tracking may be helpful for employers to ensure compliance. A comprehensive understanding of OEI mechanisms and the obstacles to increased protective eyewear use is critical to mitigate the impact of OEIs on workers.

Purpose: To compare endothelial graft outcomes after DSAEK using pre-cut tissue and surgeon cut tissue in terms of final visual outcome and graft failure at 6 and 12 months postoperatively.

Patients and methods: This retrospective study examined patients who underwent DSAEK with CB or surgeon-prepared tissue for any etiology of endothelial dysfunction. Best-corrected visual acuity (BCVA), corneal thickness, endothelial cell count (ECC), and complications were examined before and throughout the 1-year postoperative period.

Results: Total number of cases is 98 eyes of 98 patients. Fifty-five surgeon-cut grafts were compared to 43 precut grafts. Preoperative visual acuity was >/= 20/60 in 1.8% and 0.0%, >20/60-20/200 in 21.8% and 7%, and less than 20/200 in 74.6% and 86.1% for surgeon cut and precut group respectively. Visual acuity at last follow-up was >/= 20/60 in 32.4% and 5.3%, >20/60-20/200 in 29.7% and 10.5%, and less than 20/200 in 37.8% and 84.2% for surgeon cut and precut group, respectively. At 6 months, 41 (83.7%) in the surgeon cut group and 27 (67.5%) in the precut groups completed the follow-up. Of these, 10 (24.4%) and 14 (32.6%) respectively, ended up with graft failure. The statistically significant difference in graft failure was maintained until 12 months: 37 (82.2%) in the surgeon cut group and 20 (58.8%) in the pre-cut group completed the follow-up. Of these, 11 (29.7%) and 14 (70%) labeled as failed grafts, respectively.

Conclusion: We found a higher rate of graft failure 6 to 12 months postoperatively in precut tissue grafts than in surgeon cut tissue grafts despite both tissues being provided by the same eye banks.

Purpose: To evaluate the outcomes of lensectomy with and without intraocular lens (IOL) implantation in patients with Marfan syndrome and ectopia lentis.

Methods: This retrospective review included 55 patients (85 eyes) diagnosed with Marfan syndrome who underwent lens surgery at King Khaled Eye Specialist Hospital between 2014 and 2023. Preoperative lens status; surgical technique; use of capsular support devices and IOLs; and postoperative clinical, biometric, and refractive parameters were analyzed. The primary outcome was final best-corrected visual acuity. Secondary outcomes included refractive correction (spherical equivalent), axial length, intraocular pressure, IOL position and stability, and incidence of postoperative complications.

Results: All eyes had subluxated crystalline lenses [predominantly inferotemporal lenses (52.9%)]. Surgical procedures included lensectomy with anterior vitrectomy (49.4%), lensectomy with IOL implantation (38.8%), pars plana vitrectomy with lensectomy (7.1%), and phacoemulsification with IOL (4.7%). Capsular support devices were used in 12 eyes. Secondary IOL implantation was performed in 12 eyes, with 91.7% scleral-fixated IOLs. At the final follow-up, 41.2% of the eyes were aphakic, 32.9% had scleral-fixated IOLs, 15.3% had posterior chamber IOLs, and 8.2% had anterior chamber IOLs. There was a significant association between phakic status and refractive correction (P<0.001). The final mean visual acuity improved significantly from 1.1±0.7 logMAR (20/250) at presentation to 0.3±0.3 logMAR (20/40) at the last visit (P<0.001). The IOL position was stable in 47.1% of the eyes and was significantly associated with IOL type (P<0.001).

Conclusion: Lensectomy, with or without IOL implantation, is an effective and versatile approach for managing ectopia lentis in Marfan syndrome, with favorable long-term visual and anatomical outcomes. These findings emphasize the need for individualized planning based on subluxation severity and capsular support. Improved IOL stability and vision support the use of tailored techniques. Future studies should assess long-term safety and quality of life to guide standardized care.

Purpose: In this in vitro study, we investigated if the biological activity of commonly used VEGF antagonists might be affected by their passage through a newly designed 30 G needle (NDN) for intravitreal injection (IVI). To reduce the risk of intraocular inflammation compared to conventional injection with a standard hypodermic 30 G needle (SHN), the NDN contains an occluded front orifice and a side port for drug delivery, resulting in an altered direction of the injection stream.

Methods: Anti-VEGF drugs, such as ranibizumab, faricimab, and aflibercept, were passed twice through one of the two needle types to imitate IVI. To evaluate the VEGF-A-binding capacity of the un- or pretreated antagonists, VEGF-A₁₆₅ was incubated with a 1-10fold molar excess of them for 15 min at 37°C, and unbound VEGF-A was determined by ELISA. As the capture antibody and antagonists bind to the same region of the growth factor, only the non-complexed VEGF-A was measured. Biological activity of pretreated antagonists was studied by assessing their capacity to prevent VEGF-A₁₆₅-induced impairment of the barrier formed by retinal endothelial cells: VEGF-A₁₆₅ plus antagonists were added to the cells and, as a measure of permeability, the cell index was continuously monitored by electric cell-substrate impedance measurements for three days.

Results: Only a marginal amount of free VEGF-A, if any, was detected after incubation of the growth factor with a fourfold molar excess of any of the antagonists, independent of the drugs' pretreatment. VEGF-A₁₆₅-induced low cell index values, indicative of a dysfunctional barrier, were similarly prevented by different pretreated antagonists.

Conclusion: The passage of the proteins through NDN or SHN did neither affect efficient binding to their target, nor their capacity to prevent VEGF-A₁₆₅-induced barrier dysfunction. Overall, regarding the stability of therapeutic proteins, the NDN was not inferior to the SHN, and can now be considered for evaluation in clinical studies.

Purpose: Establishing effective surgical interventions for secondary glaucoma (SG) remains a significant clinical challenge. We evaluated the efficacy and safety of initial outflow reconstruction using ab interno microhook trabeculotomy in patients with SG.

Patients and methods: This retrospective study included 39 eyes from 39 patients who underwent either standalone microhooktrabeculotomy or a combined triple procedure with cataract surgery in 2021. The cohort consisted of 18 eyes with exfoliation glaucoma, 15 with uveitic glaucoma, and 6 with steroid-induced glaucoma. Intraocular pressure (IOP) and glaucoma medication scores were recorded preoperatively and at 1, 3, 6, and 12 months postoperatively. Primary outcomes included the IOP reduction rate at 12 months, assessed using mixed effects analysis, and IOP control over time, analyzed via Kaplan-Meier survival curves (failure defined as < 20% IOP reduction or IOP > 21 mmHg on two consecutive visits). Risk factors for surgical failure were analyzed using Cox proportional hazards models. Furthermore, postoperative complications and the need for additional surgical interventions were evaluated.

Results: The mean patient age was 65.1 ± 13.6 years, with 24 male participants. The mean preoperative IOP was 25.4 ± 9.3 mmHg, and the mean medication score was 4.2 ± 1.3 at 12 months postoperatively; these values significantly decreased to 14.9 mmHg and 3.1, respectively (P < 0.05). The mean IOP reduction rate at 12 months was 32.4%, and the Kaplan-Meier survival rate for IOP control was 60.3%. Cox hazard analysis indicated that older age and pseudophakia were associated with improved postoperative IOP control. The most common complication was anterior chamber hemorrhage (35.9%).

Conclusion: Ab interno microhook trabeculotomy may represent an effective initial surgical strategy for lowering IOP and reducing the reliance on glaucoma medications in patients with SG, particularly among older individuals and those with pseudophakia.

Purpose: This study aimed to evaluate the diagnostic value of the number of visible vitreous zonule (VZ) quadrants in predicting zonular laxity in patients with primary angle-closure disease (PACD).

Patients and methods: This prospective cohort study collected data between the period of November 2021 and February 2024. PACD patients were enrolled, with one eye selected randomly for analysis. The main outcome was the association between the presence/number of quadrants with visible VZ and the presence of zonular laxity. The diagnostic capability of the number of quadrants with VZ in determining zonular laxity was evaluated.

Results: A total of 50 patients were enrolled in the study. Compared with the VZ group, the no VZ group was more likely to manifest zonula laxity (14 of 14 [100%] vs 19 of 36 [53%], P = 0.002). The zonular laxity group had fewer quadrants with visible VZ (1.18 ± 0.22 vs 2.93 ± 0.22, P < 0.001) than the normal group. The number of quadrants for zonular laxity detection achieved an area under the curve of 0.855 (P < 0.001). The highest Youden Index was observed when the number of quadrants was less than 3, indicating superior diagnostic capability for zonular laxity, with a sensitivity of 84.9% and specificity of 70.6%. The highest sensitivity (93.9%) was achieved when the number of quadrants was less than 4.

Conclusion: The study found a link between VZ lack and zonular laxity in PACD, enhancing diagnosis with fewer VZ quadrants, and highlighted VZ's diagnostic value.

Purpose: Infectious keratitis, the leading cause of corneal blindness, disproportionately affects developing countries. We examined risk factors for poor presenting visual acuity in a rural Indian population.

Patients and methods: We conducted a cross-sectional study of patients ≥16 years old with active infectious keratitis at SNC Hospital, a tertiary eye hospital in north India, from June to November 2024. Variables collected were demographics, clinical features, and anatomic findings on slit-lamp examination. Binomial logistic regression measured association of variables with best-corrected visual acuity (BCVA) ≤20/200. Significant univariable associations were incorporated into a multivariable model.

Results: Among 667 patients with keratitis (mean age: 50.3 ± 15 years), 497 (74.5%) presented with VA ≤20/200. Independent risk factors for poor VA included older age (prevalence ratio [PR] 1.01/year, 95% CI 1.00-1.01, p<0.001), bacterial infection (PR 1.12, 95% CI 1.03-1.23, p=0.009), polymicrobial infections (PR 1.13, 95% CI 1.01-1.26, p=0.027), larger epithelial defect (PR 1.38, 95% CI 1.12-1.71, p=0.042 with epithelial defect diameter >6mm), posterior stromal infiltrate (PR 1.22, 95% CI 1.09-1.36, p<0.001), endothelial plaque (PR 1.13, 95% CI 1.00-1.26, p=0.043), central infiltrate location (PR 1.26, 95% CI 1.14-1.38, p<0.001) and hypopyon (PR 1.28, 95% CI 1.18-1.39, p<0.001). Travel distance, time to presentation, and clinical risk factors were not independently associated with poor VA.

Conclusion: Anatomic features including larger epithelial defects, deep stromal infiltrates, endothelial plaque, central location, and hypopyon were the strongest predictors of poor VA. These findings highlight the utility of anatomic features for identifying eyes at risk for severe outcomes and serving as biomarkers in future clinical trials.

Introduction: The purpose of this study was to evaluate the progression of hydroxychloroquine (HCQ) retinopathy following parafoveal loss of the ellipsoid zone (EZ) without retinal pigment epithelium damage (RPE).

Methods: This was a single-center retrospective case series of patients with hydroxychloroquine retinopathy who presented between 2012 and 2023 and in whom the drug was stopped prior to damage of the RPE. Patient imaging from the time of HCQ discontinuation to the most recent follow up appointment was reviewed to assess for retinopathy progression, and spectral domain optical coherence tomography (SD-OCT) images were analyzed using ImageJ2 to quantify ellipsoid zone damage.

Results: Five patients met the criteria for inclusion in this study. All patients were female, with a mean age of 69.5 ± 12.2 years. Patients had been taking HCQ for 18.2 years on average (range: 5-32 years). 40% of patients were overdosed according to real weight guidelines and 60% by ideal weight guidelines. All patients demonstrated worsening of retinopathy following drug discontinuation. The length of parafoveal zones of EZ hyporeflectivity on SD-OCT increased by an average of 26.8 ± 8.6% in right eyes and 22.5 ± 15.0% in left eyes over an average follow-up period of 31.4 months (range 8-71 months).

Conclusion: Progression of HCQ retinopathy can occur even when HCQ is discontinued before RPE damage. Ophthalmologists should be aware of the risks associated with HCQ use following damage to the EZ. The acknowledged threshold at which irreversible progression of retinopathy is predicted despite cessation of the drug may need to be reconsidered and shifted earlier than RPE loss.